People Who "Gave Up" After 9/11 More Likely to
Remain Distressed

The Sept. 11 attacks of 2001 left a lingering psychological
impact on the nation according to new research published
in the Sept. 11 issue of the Journal of the American
Medical Association (JAMA). While 17 percent
of the U.S. population living outside New York City
reported symptoms of posttraumatic stress two months
following the attacks, 6 percent continued to report
symptoms six months afterward.

A National Science Foundation (NSF)-funded study led
by Roxane Cohen Silver, professor of psychology and
social behavior at the University of California, Irvine,
was unusual because it followed people who were already
taking part in an Internet survey panel when the Sept.
11 attacks occurred. Therefore, their mental and physical
health histories were known prior to the tragedy.
The study, Silver explains, provides new insights
into how mental health workers can help people who
have experienced trauma, and dispels a number of myths
about who might be most affected by such an event.

"This investigation demonstrates that the effects of
a major national trauma are not limited to those directly
affected by it, and the degree of response cannot
be predicted simply by objective measures of exposure
to, or loss from, the trauma," Silver said. "It shows
that early disengagement from coping efforts (such
as 'giving up,' distracting oneself, or refusing to
believe what happened) predicts poor psychological
outcomes over time." Her paper for JAMA,
"A Nationwide Longitudinal Study of Psychological
Responses to September 11," was co-authored by researchers
in her department, E. Alison Holman, Michael Poulin,
and Virginia Gil-Rivas, as well as Daniel McIntosh,
a psychology professor at the University of Denver.

"Overall, our data show that six months after the events
of 9/11, the effects continued throughout the country
among individuals who were, for the most part, not
directly affected by the attacks," Silver said.

The paper was based on a national random sample of
Americans participating in an Internet-based survey.
Respondents were questioned about distress and posttraumatic
stress symptoms during the first two weeks, two months
and six months after the attacks. A total of 933 people
participated in the first and second rounds of the
survey, and 787 of those participated in the third
round.

"Posttraumatic stress symptoms, while declining over
the six months, still remained elevated. Moreover,
individuals continued to have substantial anxiety
about future terrorist attacks personally affecting
themselves or those close to them," the authors write.
Those individuals who had preexisting mental or physical
health difficulties or had greater exposure to the
attacks (including watching them on "live" TV) were
more likely to show continued stress symptoms over
time.

"We believe it is important for health care professionals
to recognize that potentially disturbing levels of
trauma-related symptoms can be present in a substantial
portion of individuals who are not directly exposed
to a trauma, particularly when the trauma is a massive
national tragedy such as the 9/11 attacks," Silver
added. "However, rather than considering these symptoms
as evidence of psychiatric 'disorders' per se, their
presence is likely to represent a normal response
to an abnormal event."